Glioblastoma Treatment: How Do Doctors Treat This Brain Tumor?

Treatment for glioblastoma , a rare but aggressive brain cancer, usually involves a care team that may include neurosurgeons, medical oncologists, and radiation oncologists.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291904a4c2-10a9-4fd3-8295-e27ceeb61bec Several factors influence the treatment plan recommended for a patient with glioblastoma, including the tumor’s location, size, spread, and your age, overall health, underlying medical conditions, and personal goals and preferences, says Brad Zacharia, MD , a neurosurgeon and the division chief of neuro-oncology and skull base surgery at Penn State Health in Hershey, Pennsylvania. “We work closely with each patient to develop an individualized treatment plan that balances effectiveness with quality of life,” he says. Your care team will help you determine which therapies are right for you.
Surgery Surgery Treatment for glioblastoma typically starts with surgery to remove as much of the tumor as possible. The cancer cells from the removed tissue are then examined under a microscope and tested for DNA differences that can help guide treatment decisions.e60dc2a1-f33c-4a05-9b50-8e3e8e597629786c78ea-18b0-4642-bd1b-370dd42c9162 “If surgery isn’t possible because of the tumor’s location or a patient’s medical condition, a biopsy is typically performed to confirm the diagnosis,” says Dr. Zacharia. This is a less invasive procedure using a needle to obtain a small piece of the tumor for testing.e60dc2a1-f33c-4a05-9b50-8e3e8e59762964cda039-b260-4040-9690-f76892255f43 Surgeons typically rely on medical imaging techniques like magnetic resonance imaging (MRI) and ultrasound to map the tumor’s location. They may also use special fluorescent dyes that light up tumor cells so they can differentiate them from healthy cells.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294aeae957-53db-4b1a-8289-09a3a68ccfdb Some people receive anesthesia for brain tumor surgery and sleep through the entire procedure. Others have an awake craniotomy, where medicine is given to induce relaxation and numb the surgical area, but you can answer questions throughout the procedure. This option can help your surgeon protect areas of the brain that control important functions, like language and movement.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294aeae957-53db-4b1a-8289-09a3a68ccfdb Even with these advanced surgical techniques, your surgeon likely won’t be able to remove the entire tumor because glioblastomas have fingerlike growths that spread through the brain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299f2c12f8-e6a7-4a1f-93ff-c2b8aa34f467 To address leftover cancer cells, surgery is almost always followed by radiation and chemotherapy.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293bc8016c-9ce7-4db1-b46d-3dc61b33615b
Radiation Radiation Radiation therapy uses beams of energy to destroy cancer cells left behind after surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629effed050-fbfd-4da2-8283-799e3a343e4f The gold standard treatment for glioblastomas is radiation given over six weeks alongside chemotherapy treatment — a combination called the “Stupp protocol.”e60dc2a1-f33c-4a05-9b50-8e3e8e597629066e187c-9138-4fde-9be5-605b73687fb6 Side effects from radiation treatment on the brain can include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ea6d05d4-4f62-43fe-8ae0-0d6c67cf559fe60dc2a1-f33c-4a05-9b50-8e3e8e59762912de61c8-222b-4299-a154-1805097f854a Extreme tiredness Hair loss Trouble with memory or concentration Nausea and vomiting Dry or peeling skin Skin color changes Headaches Vision changes Your provider may recommend one of several radiation options, depending on your tumor’s location and type.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293df82fb5-a9d4-42b1-97a4-ae7047e647cd 3D Radiation This radiation type directs energy beams at tumor cells from many directions. A radiation oncologist meticulously plans this treatment based on scans that show the tumor’s location. 3D radiation focuses more directly on cancer cells and causes less damage to nearby tissue than older 2D methods.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913b6a910-3c9b-4608-8461-c16b3d4cf3fd Intensity-Modulated Radiation Therapy Intensity-modulated radiation therapy (IMRT) works like 3D radiation, with beams aimed from several directions. But it uses smaller beams and more of them, allowing the radiation to target a very specific area. The strength of certain beams can be adjusted for even more accuracy.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913b6a910-3c9b-4608-8461-c16b3d4cf3fd Stereotactic Radiosurgery This radiation type uses more intense and focused energy beams. It works best for small tumors that have well-defined edges.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913b6a910-3c9b-4608-8461-c16b3d4cf3fd Your health facility may offer different types of stereotactic radiosurgery, including Gamma Knife or CyberKnife.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293df82fb5-a9d4-42b1-97a4-ae7047e647cd Brachytherapy With brachytherapy, a surgeon places a tiny radioactive object near the tumor during surgery. This object (usually a ribbon or capsule) releases steady doses of radiation, which destroys the tumor cells nearby.e60dc2a1-f33c-4a05-9b50-8e3e8e597629af8d5dba-c9a4-40e1-a486-02f91c5e796a Providers recommend this treatment less often because of side effects, like exposing people nearby to radiation.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293df82fb5-a9d4-42b1-97a4-ae7047e647cd Proton Therapy Proton therapy uses a different type of energy particle than other forms of radiation. Most radiation machines use photons, which target the tumor but scatter radiation to nearby areas. Proton beams can stop at the tumor site. They also deliver less radiation to nearby tissues on their way to the tumor.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913b6a910-3c9b-4608-8461-c16b3d4cf3fd The U.S. Food and Drug Administration (FDA) has approved this radiation treatment, but not every cancer center has the equipment to use it, and many insurers don’t cover the expense.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293df82fb5-a9d4-42b1-97a4-ae7047e647cde60dc2a1-f33c-4a05-9b50-8e3e8e59762913b6a910-3c9b-4608-8461-c16b3d4cf3fd
Chemotherapy Chemotherapy Chemotherapy medications destroy cancer cells. For glioblastoma, these drugs are typically taken by mouth for six weeks in combination with radiation therapy.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290bda9315-2fa3-4dba-90b5-925fc0541655 You may need chemotherapy given through a catheter in your vein (an IV or central line) for glioblastoma that comes back after treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cbda3e9b-9e00-45e5-9ca1-7191608d0206 Your provider may also recommend placing chemotherapy wafers at the tumor site during surgery. Over time, this wafer dissolves, releasing medication near the tumor.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cbda3e9b-9e00-45e5-9ca1-7191608d0206 Typical chemotherapy drugs for glioblastoma include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290bda9315-2fa3-4dba-90b5-925fc0541655 temozolomide (TMZ) (most common) carmustine (BiCNU) lomustine (Gleostine) Common chemotherapy side effects include nausea, hair loss, mouth sores, and fatigue.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299779a4a7-23d8-41c7-ae2c-5010605fac51 Temozolomide can also increase your risk of bleeding and liver injury.e60dc2a1-f33c-4a05-9b50-8e3e8e59762902d48c44-c7d2-495b-b4d4-29f681536348
Targeted Therapy Targeted Therapy Targeted therapy medications focus on specific genes or other biomarkers in cancer cells, while sparing healthy cells.e60dc2a1-f33c-4a05-9b50-8e3e8e597629732b711b-9adb-4623-a590-f456a6c6375a The FDA has approved one targeted therapy for glioblastoma: bevacizumab (Avastin). This medication is given through an IV, most often after surgery or for returning glioblastoma.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0a7126d-519b-4605-97fd-6a3b4891f430e60dc2a1-f33c-4a05-9b50-8e3e8e597629732b711b-9adb-4623-a590-f456a6c6375a Experts are studying many more targeted therapies, and your provider can recommend clinical trials that fit your glioblastoma type.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a0a7126d-519b-4605-97fd-6a3b4891f430 “For eligible patients, participation in a clinical trial may provide access to promising new therapies while contributing to future advances in glioblastoma care,” says Zacharia.
TTFields TTFields Tumor-treating fields (TTFields) is a therapy that sends mild electrical pulses through sticky patches called electrodes on your scalp. This energy helps prevent cancer cells from multiplying.e60dc2a1-f33c-4a05-9b50-8e3e8e597629da1eb37d-57e6-498e-8e9f-e693bfe444f3 The electrodes connect to a portable device with wires that you carry around in a backpack or bag. You will need to wear this device most of the day.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b6af7119-d993-47d3-b471-c64112f025f2 Your provider may recommend TTFields treatment alongside or after chemotherapy and radiation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629da1eb37d-57e6-498e-8e9f-e693bfe444f3
Immunotherapy Immunotherapy The FDA has approved no immunotherapy treatments for glioblastoma, but several are available through clinical trials. These medications help your immune system find and destroy cancer cells.e60dc2a1-f33c-4a05-9b50-8e3e8e597629008afb29-fe2a-40c2-acfd-cc582370497ce60dc2a1-f33c-4a05-9b50-8e3e8e59762935453971-ae68-4e34-bf96-21e6e428f7cb In ongoing studies, immunotherapy for glioblastoma can be given through an IV or placed next to the tumor during surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e59762981a61155-2589-446c-9869-0ee74d0c16cb Side effects vary by the medications used, but can include fatigue, diarrhea, brain swelling, and liver problems.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292560b4c0-d1fb-4aca-8ae7-7d0155ae28e2e60dc2a1-f33c-4a05-9b50-8e3e8e5976295d1dc234-94fd-4576-8954-ed3edcbc01ba
Rehabilitation and Therapy Rehabilitation and Therapy Rehabilitation can help you recover after brain tumor surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296676ddb1-f571-4c6f-a8b2-55454737de71 “Most patients will require an evaluation by physical and occupational therapy after surgery for glioblastoma,” says Rafael Uribe-Cardenas, MD , a neurosurgeon at White Plains Hospital in White Plains, New York. Depending on how the tumor affects your movement, speech, thinking, and other brain functions, you may also need speech therapy, says Zacharia. “These services can help patients maintain independence, improve function, and maximize their quality of life throughout treatment and recovery,” he says.
Complementary and Integrative Approaches Complementary and Integrative Approaches Many providers also recommend integrative therapies to manage the emotional distress that can come with a glioblastoma diagnosis. These may include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629fe2c1823-164a-4d22-843f-3d9d2030c5cc Regular exercise Massage Art therapy Mindfulness and meditation Music therapy
Palliative Care Palliative Care Palliative care specialists can help you stay more comfortable and supported throughout glioblastoma diagnosis and treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291d2effbc-9051-4cb1-96a1-db4457eae031 Unlike hospice, palliative care doesn’t focus on end-of-life care. Instead, the goal is to improve your quality of life as you choose and receive treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e59762967295a62-a9a7-4b6f-a7eb-c38fd851c89d Palliative care providers offer additional pain management solutions and support for emotional, social, mental, and spiritual health.e60dc2a1-f33c-4a05-9b50-8e3e8e59762967295a62-a9a7-4b6f-a7eb-c38fd851c89d “We take a proactive approach to palliative care, introducing it early to our patients with a new diagnosis of glioblastoma,” says Zacharia. Palliative care offers resources for loved ones, too. “Early involvement also provides valuable support for families and caregivers as they cope with the physical, emotional, and practical challenges of the disease,” says Zacharia. Some people choose to focus on palliative care rather than aggressive treatment, says Dr. Uribe-Cardenas. You may not want to go through treatment, or want to focus on quality of life if glioblastoma returns, he says. No matter your treatment choices, your palliative care team can help you live life to the fullest.
Mental Health Treatment Mental Health Treatment Living with a glioblastoma diagnosis can feel overwhelming, and you may have intense emotions about your condition and trouble sleeping.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294993867f-a721-4312-9300-5e7f3358b3f2 “It is common for patients being treated for glioblastoma to report mental health symptoms,” says Zacharia, who works with specialists to provide counseling, supportive services, and medications when appropriate to help patients and their families throughout treatment. Uribe-Cardenas says he’s always open to discussing mental health with his patients. “ Mental health must be prioritized always, and patients must be referred to the appropriate mental health specialist as soon as the need is identified,” he says. Some find comfort by joining a support group and hearing from others who understand their experience. You can find support groups through these organizations:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291569cf7f-c517-48c5-93c2-9a53d25a7d3e Glioblastoma Foundation National Brain Tumor Society American Brain Tumor Association You can also find programs with organizations like the Brain Tumor Network that match you with a mentor who can help you navigate the complex medical world of providers, clinical trials, and treatments.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291569cf7f-c517-48c5-93c2-9a53d25a7d3e Your provider can recommend local resources to support your mental health. No matter which path you take, it’s important to find someone to talk to about your diagnosis.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294993867f-a721-4312-9300-5e7f3358b3f2
Resources We Trust Mayo Clinic: Glioblastoma: Diagnosis and Treatment Cleveland Clinic: Glioblastoma (GBM) American Brain Tumor Association: Glioblastoma (GBM) The University of Texas MD Anderson Cancer Center: Glioblastoma Treatment Johns Hopkins Medicine: Glioblastoma Multiforme (GBM): Advancing Treatment for a Dangerous Brain Tumor